Learn more about what treatments are on the rise for plaque psoriasis, the latest management advice and what trends are shaping the future of the disease. 

The changing treatment landscape of plaque psoriasis

Something I hear over and over again from patients, with vitiligo and otherwise, is that people often think they’re contagious. So this is a really difficult way to go about life. I think it’s, of course, a disease that we really want to take seriously. I feel like the psychosocial impact is so important. I’m curious what your perspective on the matter is. How do you support patients through this, outside of medical treatment?

: I think you hit the nail on the head. This is a disease that should be treated by all of us as a medical skin condition. This is not a cosmetic disease, and that’s actually one of the first things I tell my patients. When I walk into an examination room, they’re coming to see me as a pigment specialist; I have patients who come from all over the country, some internationally, and the level of anxiety, you can almost cut the tension with a knife when you walk into some of these rooms with these patients, as you know. Part of that is because it’s such a stigmatizing disease in many cultures, especially from my background, which is from the Indian subcontinent. Many of my patients are from African countries, even Latin American countries. And of course, in Asia, skin pigmentation is very much culturally linked to one’s self-identity and oftentimes, in many cultures, linked to socioeconomic status and the way they’re viewed in their community and culture.

I’ve heard everything from, “You need to fix this for my child or they’re never going to get a marriage proposal,” to, “They’re never going to be accepted into school. This is not accepted in our families.” People get disowned. This leads to a profound psychological impact. I’ve seen a lot of cases of major depressive disease, or hypomanic disease, also unfortunately, suicidal ideation in some patients who have been ostracized from their families. This is real, and it’s something that I think we have to tackle head on. One of the things I do with my patients is to acknowledge that. I think we have to say, “This must be having a profound impact on you. Tell me about how you feel.” It’s really fascinating how many people come to me, and they’ve seen great colleagues who’ve treated the disease, or attempted to treat the disease, but really that 5-minute discussion and just asking the patient, “Really be honest with me and tell me how you’re feeling.” I hear very frequently, “Yes, I don’t feel like going to work. I’m really glad that I’m working from home and virtually so I don’t have to show someone my skin.” I’ve heard that a lot during COVID-19. I’ve heard a lot about, “Oh, I like doing Zoom meetings because then I can cover up with makeup and no one can see that the makeup doesn’t really match my normal skin.”

So, these impacts are profound. I think from a practical perspective, I do get psychological therapy for some of my patients. I do have a clinical psychologist and a psychiatrist in my referral network for some of the patients who need it, and there are patients who need that, and it’s OK. I think making sure patients understand that this is something that is very much linked to one’s sense of beauty and their own identity, especially in many cultures, is important to tackle head on.

: Thanks, that was a beautiful summary of the impact of the disease. I really cannot agree more, the profound impact that this medical disease has on patients’ quality of life. I fully agree with you that acknowledging how difficult it is can be therapeutic to patients. I’d love to talk about treatment; I think we will soon, but I’d like to also acknowledge how difficult treatment can be. It requires a real commitment. I think acknowledging that treatment is not easy can also really help support our patients.

Videos

Shared insight on the psychological and social impact of vitiligo, along with practical advice on how to communicate with and support patients.

Understanding the Psychosocial Impact of Vitiligo

 presentation titled, “Innovations in the Treatment of Vitiligo.” I’m Dr Seemal Desai. I’m a board-certified dermatologist in private and academic practice in Dallas, Texas. I’m the founder and medical director of Innovative Dermatology and serve on the faculty at University of Texas Southwestern Medical Center, where I teach residents and see patients. I’m joined today by a friend and colleague, Dr William Damsky, who is an assistant professor in the Department of Dermatology and Dermatopathology at the Yale School of Medicine in New Haven, Connecticut.

In our discussion today, we’ll focus on an overview of vitiligo, with clinical presentation, nuances, new research that’s out there, and diagnostic and therapeutic management. We’ll also discuss goals of therapy with the available items in our treatment armamentarium, but most importantly, what are the new advances that Bill and I are most excited about for patients with vitiligo based on our expertise in clinical research? Welcome, and let’s get started. Bill, it’s great to be with you as well.

: Likewise. It’s a pleasure to talk with you today.

Why don’t we set the stage for our audience and our viewers and just tee it up with, what is vitiligo? We may have people watching us today who don’t see a lot of these cases. Obviously, my bias is, I do this all day long in my pigment practice, and you’re actively involved with us in clinical research, but what is vitiligo? What causes it? How common is it? Tell us your thoughts.

: Thanks for the question. Really at its heart, vitiligo is an autoimmune disease. Autoimmune diseases are diseases of the immune system where the immune system is hyperactive, meaning that it goes after targets that probably it shouldn’t. The target of the immune response in vitiligo is the cell type of melanocytes. Melanocytes are normal pigment-producing cells in the skin, and when they’re recognized and eliminated by the immune system, they no longer produce pigment. This leads to clinical patches of depigmentation as we see in vitiligo. Vitiligo is actually quite common. Estimates worldwide suggest that 1 in 200, or up to 1 in 50 individuals are affected by the disease. In terms of the cause, really, the root cause isn’t known, but we tend to think of it as an autoimmune spectrum disorder, which probably reflects a combination of genetics, environmental exposures, and potentially, even a little bit of bad luck. Clinically, I think many people may be familiar with the presentation of vitiligo. We look for depigmented patches of skin, they’re typically symptomatic, and that’s usually what the patients will come to see us for.

 I agree. It’s interesting because this disease can not only have a profound impact on the patient but also on the family who’s dealing with this, especially for the pediatric and adolescent patients we see. And of course, we’ll dive into more of that, I’m sure, later in our discussion together, especially given some of the cultural, social, and psychological influences of the disease. Let me just follow up with you on one important point, do you find your patients ever complain about certain symptoms associated with vitiligo, aside from the obvious loss of [skin] color? Are there any specific skin signs or symptoms that you wanted our listeners to be aware of?

: That’s a great question. I appreciate you asking it. In general, I feel like patients don’t typically present with symptoms, such as itching or burning or pain; itching may be a symptom, sometimes patients have concomitant atopic dermatitis and those patients may be a little bit itchier than the rest. Something that really seems to bother patients, and this is true of vitiligo but it’s also true about other skin disorders, is it’s really hard to go about normal daily life. It may be hard to expose certain parts of the skin. If the face is affected, it may be impossible to shield it.

Expert dermatologists Seemal Desai, MD, FAAD, and William Damsky, MD, PhD, provide an overview of vitiligo, as an autoimmune disorder, and its prevalence.

An Overview of Vitiligo

and joined the MJH Life Sciences team in April 2021. She graduated from Kent State University in 2018 with a bachelor's degree in journalism and a minor in sociology. Linda used to work as a creative writer for 

 and was a technical writer/regulatory specialist/purchasing agent at GM Industrial before coming on to the team. She enjoys reading, traveling, and learning new perspectives. You can reach her at 

In this exclusive interview with Dermatology Times®, John Dobak, MD, the president and CEO of 

, a genomics company in dermatology that’s dedicated to revolutionizing skin cancer detection, discuses the DermTech Melanoma Test and the 

Laura Ferris, MD, PhD, a dermatologist and associate professor at the University of Pittsburgh Clinical and Translational Science Institute Director of Clinical Trials, UPMC Department of Dermatology, also talked about how to evaluate patient risk factors, patient education, and how Covid-19 has affected melanoma detection. 

In this video interview we sit down with John Dobak, MD, and Laura Ferris, MD, PhD, to talk about DermTech, the TRUST study, and more. 

Advances in Skin Cancer Diagnosis and Education

Keith A. Reynolds is contributing author for 

At a time when high drug prices are adding to patients’ high medical bills, few physicians are accurate when estimating of out-of-pocket costs.

 in a study of 371 primary care physicians, gastroenterologists, and rheumatologists found that only 21% of respondents could accurately estimate out-of-pocket 

 when supplied with information on the drug’s price and the patients insurance plan’s cost-sharing mechanisms.

Specifically, the respondents were asked to estimate the out-of-pocket 

 for a patient prescribed a new medication costing $1,000 a month without insurance. They were supplied with a summary of the patient’s insurance information including deductible, coinsurance rates, copays, and out-of-pocket maximum and were asked to estimate the cost at four points between January and December. They were asked to use the plans four types of cost sharing: deductibles, coinsurance, copays, and out-of-pocket maximums, the study says.

Overall, 52% of respondents were able to accurately estimate the 

 before the deductible was met, 62% were able to accurately use coinsurance information, 61% accurately used copay information, and 57% accurately estimated the costs once the out-of-pocket maximum was met. Only 21% were able to answer all four correctly, according to the study.

The survey also looked at the respondents’ attitudes toward 

 Most of the respondents (74%) agreed that they had an obligation to initiate cost conversations but had difficulty advising patients of out-of-pocket costs (77%). Main barriers to these conversations cited by the respondents were insufficient time (76%), insufficient knowledge (69%), and discomfort with the conversations (41%). A further 63% reported their patients expected them to solve their cost-related issues, the study says.

“Our study provides some hope that an EHR-based cost estimator could improve physician awareness of drug costs,” the study says. “Although we did not ask physicians to specify the details of their EHRs, those who reported having access to some information about out-of-pocket costs performed better than those who had no information.”

This article was initially published by our sister publication

Articles

Less than a quarter of physicians could accurately estimate out-of-pocket drug costs.

Study: Physicians usually wrong when estimating patients’ out-of-pocket drug costs

In many areas of the country, winter weather can be hard on the skin. Cold, dry air can chap and dry skin—especially the delicate skin of infants.

More than a third of all children younger than age 2 years experience some type of eczema and another quarter face allergic skin diseases.

 Winter irritation can make these problems worse, but there are ways to protect infant skin, whether it’s particularly sensitive or not.

“One of the little tricks in children who have issues with ichthyosis or who have a history of eczema is to be careful about keeping the skin covered,” said Bernard Cohen. Cohen is a professor of pediatric dermatology the Johns Hopkins School of Medicine and director of the Johns Hopkins University Pediatric Dermatology and Cutaneous Laser Center in Baltimore, Maryland.

Skin that is most exposed tends to get the worse of fall and winter irritation, he added. This can include the diaper area, but really applies to all areas of the skin.

Moisture is key, as studies show that regular moisturizing can help improve skin barrier function and reduce irritation. One 2017 study showed reduced diaper rash and other skin problems simply from using daily moisturizer and bathing infants every other day.

 Cohen said moisture is an important tool when it comes to preventive winter skin care.

“I do think it’s important to use moisturizers and barrier creams in the diaper area all the time,” Cohen noted, adding barrier cream should be considered for every diaper change in infants with existing skin problems. “In children who have very sensitive skin, barrier cream or ointment in the diaper area should be used as regular preventive care.”

Considering how skin is cleaned can play a role, too. A 2020 study revealed that diaper rash rates varied in cultures, with infants in China having lower prevalence than infant populations in the Unites States and Germany.

 How infants were cleaned played a role, according to the study, with caregivers in China performing deep cleaning with soap and water with bowel movements, but often skipping wipes for urine-only diaper changes. Caregivers in United States and Germany tended to use commercial wet wipes most regardless of the type of diaper change. Cohen said caregivers should consider simple, gentle wiping with mineral oil for infants with delicate skin or who are prone to diaper dermatitis.

1. Özcelik S, Kulac I, Yazici M, Ocal E. Distribution of childhood skin diseases according to age and gender, a single institution experience

. 2018;53(2):105-112. doi:10.5152/turkpediatriars.2018.6431

2. Yonezawa K, Haruna M, Matsuzaki M, Shiraishi M, Kojima R. Effects of moisturizing skincare on skin barrier function and the prevention of skin problems in 3-month-old infants: a randomized controlled trial. 

. 2017;45(1):24-30. doi:10.1111/1346-8138.14080

3. Carr A, DeWitt T, Cork M, et al. Diaper dermatitis prevalence and severity: global perspective on the impact of caregiver behavior. 

. 2019;37(1):130-136. doi:10.1111/pde.14047

Dropping temperatures and dry air can wreak havoc on anyone's skin, but especially the delicate skin of an infant. Prevention is the best tactic to keep skin healthy.

Preventive Skin Care Takes Center Stage in Winter

The U.S. health system continues to fail people of color as disparities are exacerbated by the COVID-19 pandemic.

According to a news release, The Commonwealth Fund’s new health equity scorecard, 

Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State

 found that Black Americans in nearly every state are more likely than their white peers to die from preventable and treatable conditions exacerbated by the lack of timely, high quality health care. Even among high-performing states the racial and ethnic disparities can be severe.

Specifically, the healthcare system in Minnesota, which regularly performs well in Commonwealth Fund state scorecard rankings, sees some of the largest health disparities between white and nonwhite patient communities. Other traditionally high-scoring states like Maryland, Massachusetts, and Connecticut which provide some of the best care in the country to white patients provide far worse care to many populations of color, the release says.

Even in states with historically poor care for 

 alike such as Mississippi and Oklahoma white patient still received much better care than their Black peers, according to the release.

The scorecard also ranked each state on how well the health system is working for each racial and ethnic group. It found that California’s healthcare system works better for Latinx/Hispanic people than the system in Texas, but both systems benefit white people more. South Dakota, North Dakota, Montana, and Wyoming all have the worst-performing health systems for the American Indian population while California’s healthcare system is ranked at the top, the release says.

Among the factors leading to these persisting inequities the scorecard finds structural racism and continuing disinvestment in communities of color to be the chief. Many racial and ethnic minorities face an unequal health system and are less likely to have health insurance and more likely to have cost-related barriers to care. The 

These inequities are maintained and reinforced through past and current policies at the federal, state, and local levels. The scorecard’s authors recommend these actions to create a more equitable healthcare:

Ensuring affordable, comprehensive, and equitable healthcare insurance for all

Lowering administrative burden for patients

 varying across states, there are opportunity for state-level programs tailored to address the specific needs of minority communities within the state.

This content was originally posted by our sister publication Medical Economics. 

Racial and ethnic inequities persist in all 50 states.

Healthcare equity scorecard finds system failing people of color

Yesterday, the Procter & Gamble Company (P&G) voluntarily recalled all lots with the expiration date of September 2023 of certain Old Spice and Secret aerosol spray antiperspirants and Old Spice Below Deck aerosol spray products sold in the United States.

 The UPC codes and product names are below for the recalled products. This recall was due to the detection of the carcinogen benzene. 

Benzene is classified as a human carcinogen. Exposure to benzene can occur by inhalation, orally, and through the skin and can result in cancers including leukemia and blood cancer of the bone marrow and blood disorders which can be life-threatening. 

Based on exposure modeling and the cancer risk assessments published by the Environmental Protection Agency (EPA) (IRIS database), daily exposure to benzene in the recalled products at the levels detected in the testing would not be expected to cause adverse health consequences, according to the 

To date, The Procter & Gamble Company has not received any reports of adverse events related to this recall and is conducting this recall out of an abundance of caution.

These products have been distributed across the US through both online and in-stores sales. All other Old Spice and Secret products are not impacted by this issue and may continue to be used as intended, according to the company. 

P&G has alerted retailers to remove the products and will also offer reimbursement for consumers who have purchased products impacted by the recall. They advise that consumers should stop using affected products and dispose of them properly. 

how to contact the company please click here.

This news comes after Valisure, a private pharmaceutical company, filed an FDA Citizen Petition on the findings of benzene in several brands and batches of antiperspirant body sprays. The highest contamination was in Old Spice branded body spray. It was found that 54% of the 108 batches from 30 different brands tested by Valisure contained detectable benzene, with some batches containing up to 9 times the emergency FDA limit of 2 parts per million (ppm). 

“These findings build upon our now validated discovery of 

 of antifungal sprays Tinactin and Lotrimin. In addition, Valisure detected 

,” David Light, the founder and CEO of Valisure, commented.

Links to the citizen petition and more information can be found here.

The most contaminated batch, Old Spice branded body spray, contained 17.7 ppm of benzene. If a 5-gram application of this contaminated aerosol is sprayed in a bathroom it could potentially increase the level of benzene to approximately 15 times the EPA-estimated threshold for increased cancer risk.

Brands in which benzene was detected at 2 ppm or higher include Old Spice, Secret, Tag, Sure, Equate, Suave, Right Guard, and Brut.

Many petroleum products are used as raw materials or inactive ingredients in consumer healthcare products. Particularly with body sprays, “propellants” like butane, isobutane, propane, and alcohol are commonly used and could potentially be sources of benzene contamination. 

Samples from brands containing significant benzene were analyzed by Yale University’s CBIC analytical laboratory and the contamination was confirmed.

Light did comment on the voluntary recall. "We at Valisure applaud Procter & Gamble for its quick attention to and action on our findings published in our FDA Citizen Petition on benzene contamination in body sprays," he said. "These product contamination issues might be attributed mainly to quality problems starting at the raw materials. These and other issues identified by Valisure strongly underscore the importance of independent testing and its need to be better integrated into an increasingly complex and vulnerable global supply chain."

Light continued. "We hope regulators and manufacturers continue to take further action on body sprays and other products affected by carcinogenic contamination so that consumers do not need to worry about exposure to unnecessary risk."

1. P&G issues voluntary recall of specific old spice and secret aerosol spray antiperspirants and old spice below deck aerosol spray products due to detection of benzene. U.S. Food and Drug Administration. Press release. Published November 24, 2021. Accessed November 24, 2021. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/pg-issues-voluntary-recall-specific-old-spice-and-secret-aerosol-spray-antiperspirants-and-old-spice

Procter & Gamble have issued a voluntary recall of specific Old Spice and Secret brand aerosol antiperspirants and Old Spice Below Deck aerosol spray due to benzene detection.  

Procter & Gamble Issue Voluntary Recall of Certain Old Spice, Secret Products

Acne scars are a distressing and long-term consequence of acne vulgaris and often have a damaging effect on the acne patient’s physical, mental, and social well‐being. While many treatments are available, international treatment guidelines have not been updated to current practices.

For the first time, 24 renowned, international plastic surgeons and dermatologists from 12 different countries collaborated to provide a consensus on what is the most effective treatments for specific acne scar cases.

The review article, led by Ofir Artzi, MD, director of aesthetic dermatology at Tel Aviv Medical Center, Israel, is titled, “Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations.” 

This study, published in Lasers in Surgery and Medicine (LSM), the official journal of the American Society for Laser Medicine and Surgery (ASLMS), was selected as the November 2021 Editor’s Choice, according to the press release.

The article includes discussion and panel recommendations on the role of energy-based devices (EBDs) in minimizing and treating acne scars in patients with active acne. It also covers the use of EBDs for the treatment of different acne scar types focusing on commonly used laser platforms like vascular lasers, ablative fractional lasers (AFLs) and non‐AFLs (NAFLs), while also diving into treatment combinations, and acne scar treatments in skin of color (SOC). 

“There is a paucity of high‐quality clinical studies supporting many acne scar therapies and combinations. This study is aimed to provide clear, stepwise, consensus‐based treatment recommendations for the different types of acne scars,” Artzi said.

1. International consensus recommendations for the treatment of acne scars. American Society for Laser Medicine and Surgery. Press release. Published November 10, 2021. Accessed November 23, 2021. 

https://www.aslms.org/about-aslms/media-center/news/2021/11/10/international-consensus-recommendations-for-the-treatment-of-acne-scars

Twenty four international plastic surgeons and dermatologists came together to provide a consensus on the treatment of acne scars.  

International Consensus Recommend Acne Scar Treatments

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho.

Dustin Portela, DO, a board-certified dermatologist and dermatologic surgeon at Treasure Valley Dermatology in Boise, Idaho, reviews the Clear Start Breakout Clearing kit which includes the Breakout Clearing Foaming Wash, the Breakout Clearing Booster, and the Cooling Aqua Jelly Moisturizer. See what he has to say below.

Opinions expressed are that of Portela and do not express the views or opinions of Dermatology Times®.

In this week’s Pointers with Dr Portela, the 208SkinDoc reviews the Clear Start Acne kit and takes a deep dive on the ingredients in the products.  

Pointers With Dr Portela: Clear Start Acne Kit Review

David Mandell, JD, MB, who is an attorney and founder of the wealth management firm OJM Group in Cincinnati, Ohio and Adam Braunscheidel, who is a wealth adviser at OJM Group, talk to 

 about qualified retirement plans (QRPs).

They tackle questions about important roles needed for a medical practice's QRP, how to know if a physician is paying too high of fees for their QRP, and more.  

To learn more about OJM group, please visit their website 

In this video interview, David Mandell, JD, MB, and Adam Braunscheidel, discuss why physician practices often have difficulties with retirement planning

Healthcare equity scorecard finds system failing people of color

Procter & Gamble Issue Voluntary Recall of Certain Old Spice, Secret Products

International Consensus Recommend Acne Scar Treatments

Pointers With Dr Portela: Clear Start Acne Kit Review

Experts Discuss How to Know if Your Practice’s Retirement Plan at Risk

The changing treatment landscape of plaque psoriasis